The Severe Chronic Irritability Concept: A clinical dimension to consider in child and adolescent.
Le concept d’irritabilité chronique sévère : une dimension clinique à prendre en compte chez l’enfant et l’adolescent
Résumé
For a decade, the concept of irritability has known a renewed interest in infant and child psychopathology. Indeed, longitudinal follow-up studies clearly highlighted their predictive value - in the short, medium and long terms - of a broad field of behavioral disorders and emotion dysregulation. This dimensional and transnosographic approach of irritability, coupled with the latest neuroscience data, points out that irritability could be the equivalent of a psychopathological marker, covering both a neurobiological, cognitive and emotional component. It is a major challenge today to better understand the developmental sequence of severe chronic irritability and its predictive influence on the etiology of mental disorders from childhood to adulthood.
METHOD:
We briefly review here the latest current data on this topic.
RESULTS:
The important point is that chronic and non-episodic irritability in children, associated with strong emotional sensitivity to negative events and frequent access of anger, could have a predictive value for progression to anxiety disorder or severe mood disorder but not to bipolar disorder as it was believed until now. The risk of developing a bipolar disorder would be more frequently correlated with the notion of transient and episodic irritability in a context of previous family history of bipolar disorder.
CONCLUSION:
Further studies are expected to narrow the discriminative validity of this notion of severe irritability and confirm or not its relevance as a major clinical criterion of Severe Mood Disorders in children and adolescents introduced in the last version of DSM (DSM-5).
La notion clinique d’irritabilité connaît depuis une dizaine d’années un regain d’intérêt en psychopathologie infanto-juvénile. Et ceci au travers de plusieurs données récentes de la littérature, issues notamment d’études de suivi longitudinal, qui ont clairement souligné son caractère prédictif, à court, moyen et long termes, pour un vaste champ de troubles du comportement et de la régulation des émotions. Cette approche dimensionnelle et transnosographique de l’irritabilité, associée aux dernières données des neurosciences, pourrait faire de l’irritabilité l’équivalent d’un marqueur de type psychopathologique, recouvrant à la fois une composante neurobiologique, cognitive et émotionnelle, dont il importe aujourd’hui de mieux comprendre la séquence développementale et son influence prédictive sur l’étiopathogénie des troubles mentaux de l’enfance à l’âge adulte.